Jasmin Terrace at Bakersfield

Allegation investigated: Staff do not keep the facility free of insects/spiders

Licensing Program Analysts (LPA) Shawna Doucette arrived at the facility unannounced to conduct a complaint investigation. LPA met with Administrator Ramona Eleco. LPA's disclosed the purpose of the inspection and was granted entry into the facility by the Administrator. LPA reviewed records and interviewed Administrator. LPA interviewed the pest control technician. LPA obtained copies of faclities pest control records. Based on interviews and records review, facility has a pest control service that is servicing monthly. This agency has investigated the complaint alleging, Facility staff abandoned resident at the hospital. Based on interviews and records review, We have found that the complaint was UNFOUNDED, which means the the allegation could not have happened, and/or is without reasonable basis, therefore we have dismissed the complaint. A copy of this report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Oct 30, 2023 · control 24-AS-20231024154146

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Darius Williams conducted a visit to return Resident 1's file. LPA Williams met with Administrator and provided R1's file. An exit interview was conducted and a copy of this report will be provided via e-mail.the state’s words, verbatim · CDSS document, Oct 4, 2023

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Darius Williams conducted a visit to the facility. LPA Williams met with Administrator Mona and discussed the purpose of the visit. LPA Williams toured the facility and noticed Resident 1 lying in their bed with full bed rails (bed rails the entire length of the bed). LPA Williams reviewed their Hospice Care Plan, dated 8/29/2023, and only located mention of half bed rails. Administrator did not locate any mention of full bed rails in the Hospice Care Plan. Administrator reported she will contact R1's hospice agency and either change to half bed rails, as stated in the care plan, or specify the need for full bed rails. Plan of correction was reviewed and discussed with the Administrator. An exit interview was conducted and a copy of this report will be provided via e-mail.the state’s words, verbatim · CDSS document, Sep 29, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Sep 30, 2023

..(5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who... have a hospice care plan that specifies the need for full bed rails. This requirement was not met evident by: Based on observation and record review, the Licensee did not ensure the use of full bed rails was specified in R1's hospice care plan, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 29, 2023

Plan of correction: Administrator agreed to contact R1's Hospice Agency and request the bed be changed to half rails or specify the reason for ful bed rails by POC due date of 9/30/2023.

Type of visit: Office

An informal meeting was held on 09/13/2023 at the Fresno Regional Office. The purpose of the informal meeting was to discuss recently identified issues/concerns associated with the operation of the facility. The informal meeting process was explained during this meeting. The following were in attendance: Virginia Garcia, Licensee Representative Ramona Eleco, Administrator Sergiy Pidgirny, Licensing Program Manager Shawna Doucette, Licensing Program Analyst Lisett Padgett, Licensing Program Analyst Licensee agrees to submit a plan of resolution of the issues listed to Licensing by 09/29/23. The following concerns were addressed: Responsibility of Licensing Governing Body, Administrator Qualifications and Duties, Care and Supervision, Medications, and Reporting Requirements. TSP was offered to Licensee. Licensee was provided with copies of all applicable regulations and/or Health and Safety Code and a copy of this report.the state’s words, verbatim · CDSS document, Sep 13, 2023

Allegation investigated: Staff do not respond in a timely manner to resident’s calls for assistance

Licensing Program Analyst (LPA) Shawna Doucette arrived unannounced to conduct an initial 10-day complaint inspection. LPA conducted an investigation and delivered findings. LPA explained reason for the visit and met with Administrator Ramona Eleco. LPA requested copies of C1's file. LPA interviewed residents and staff. LPA requested copies of staff schedule, resident roster that includes incontinent and non ambulatory clients in care. LPA requested the record of the signal system showing when signal system was pulled and response times. Administrator stated the facility signal system does not record this information. LPA checked the signal system and a light will blink outside of the clients door. Once the pull chord is pulled the office staff are notified. After reviewing records and conducting interviews, facility has one caregiver assigned per hall. After conducting interviews, staff did not responded for over an hour to a client needing assistance. Substantiated Based on record review and interviews, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. An exit interview was conducted with Administrator Ramona Eleco and a copy of this report along with appeal rights and plan of correction were provided.the state’s words, verbatim · CDSS document, Sep 6, 2023 · control 24-AS-20230905092100

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Sep 29, 2023

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement was not met as evidenced by: Licensee did not respond to signal system for over an hour to assist C1, which poses an immediate health safety and or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Sep 6, 2023

Plan of correction: Plan of Correction POC Licensee agrees to do staff training on meeting the clients needs and submit a plan for staffing to meet clients needs by POC due date

Allegation investigated: Staff did not respond to residents call for help Staff are not properly cleaning ice machine Facility juice machine is in disrepair

Licensing Program Analyst (LPA) S. Doucette and LPM S. Moua conducted a joint inspection. The above complaint allegations were discussed and reviewed with Administrator Ramona (Mona). The Department toured the facility and checked the ice and juice machines. The juice and ice machines were observed with mold and required cleaning. During an inspection, LPAs observed a resident left outside calling for help. Resident is non-ambulatory and was in a wheelchair. The above allegations are Substantiated. Deficiencies are cited on the attached 9099-D. Appeal rights were provided. Exit Interview was conducted. Substantiatedthe state’s words, verbatim · CDSS document, Aug 22, 2023 · control 24-AS-20230808083126

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 1, 2023

87303(a) Maintenance and Operation - The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: Based on observation, LPA and LPM observed the ice and juice machines with mold, which poses a potential health and safety concerns to the residents in care.the state’s words, verbatim · CDSS document, Aug 22, 2023

Plan of correction: Plan of Correction POC Licensee agrees to clean the ice and juice machine by POC due date 09/1/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Sep 1, 2023

87468.1(a)(1) Personal Rights of Residents in All Facilities- Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on observation, LPAs observed R1 left outside calling for help, which poses a potential health and safety concern.the state’s words, verbatim · CDSS document, Aug 22, 2023

Plan of correction: Plan of Correction POC Licensee agrees to conduct training on personal rights by POC due date 09/01/23

Allegation investigated: Staff are overmedicating resident Staff did not seek medical attention for resident

Licensing Program Analyst (LPA) S. Doucette and LPM S. Moua conducted a joint inspection. The above complaint allegations were discussed and reviewed with Administrator Ramona (Mona). The Department conducted interviews and reviewed resident’s files. Emergency services were sought for R1 after a fall. R1 was later discharged from the hospital and back to the facility. During an inspection tour, LPA observed R1 at the facility. MARs were reviewed for R2 and medications were administered as prescribed. The above allegations are Unsubstantiated. Exit interview was conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 22, 2023 · control 24-AS-20230608123710

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff did not seek timely medical attention

Licensing Program Analyst (LPA) S. Doucette and LPM S. Moua conducted a joint inspection. The above complaint allegations were discussed and reviewed with Administrator Ramona (Mona). The Department conducted interviews and reviewed resident’s files. Emergency services were sought for R1 after a fall. R1 was later discharged from the hospital and back to the facility. The above allegation is Unsubstantiated. Exit interview was conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 22, 2023 · control 24-AS-20230605121744

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Facility staff abandoned resident at the hospital

Licensing Program Analysts (LPA) Shawna Doucette and Licensing Program Manager (LPM) See Moua arrived at the facility unannounced to conduct a complaint investigation. LPA and LPM met with Administrator Ramona Eleco. LPA's disclosed the purpose of the inspection and was granted entry into the facility by the Administrator. LPA reviewed records and interviewed Administrator. Based on interviews and records review, R1 was returned to the facility on Hospice. This agency has investigated the complaint alleging, Facility staff abandoned resident at the hospital. Based on interviews and records review, We have found that the complaint was UNFOUNDED, which means the the allegation could not have happened, and/or is without reasonable basis, therefore we have dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Aug 22, 2023 · control 24-AS-20230717170914

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPA) Shawna Doucette and Licensing Program Manager (LPM) See Moua arrived at the facility unannounced to conduct the continuation of the Required Annual Inspection. LPA and LPM met with Administrator Ramona Eleco. LPA's disclosed the purpose of the inspection and was granted entry into the facility by the Administrator. LPA and LPM toured the facility and reviewed records. Photos were taken. Deficiencies were issued on 809D. An exit interview was conducted and a copy of this report, plan of corrections and appeal rights were provided to Administrator Ramona Elecothe state’s words, verbatim · CDSS document, Aug 22, 2023

The state marks this report as 8 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

LPA Shawna Doucette arrived at the facility unannounced to return R1's file. LPA met with Staff Ariadna Ku at the front office. R1's file was returned. A copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 19, 2023

Allegation investigated: Medication not being given at proper times & times PRNs are dispensed is not being recorded Medication is being falsly recorded as being dispensed to residents

Licensing Program Analyst (LPA) Shawna Doucette arrived unannounced to conduct a complaint investigation. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Administrator Ramona Eleco. LPA obtained R1's file and interviewed Administrator. LPA reviewed files. LPA took file to make copies and will return file on 08/19/23. LPA obtained records from the pharmacy and the doctor's office. Based on record review and interviews, medication Buspirone was discontinued but was being recorded on the MARS log as being given to R1 three times a day. Based on record review and interviews, PRN medications shows on the MARS a narcotic is being administered once per day and 90 pills are prescribed each month. The prescription is being filled every 30 - 60 days and there are numerous missing pills. Facility does not have an overflow. Substantiated Based on record review and interviews, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. An exit interview was conducted with Administrator Ramona Eleco and a copy of this report along with appeal rights and plan of correction were provided.the state’s words, verbatim · CDSS document, Aug 16, 2023 · control 24-AS-20230512105325

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(b)(3) · Plan of correction due date: Aug 17, 2023

87465 Incidental Medical and Dental Care (b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement was not met as evidenced by: Licensee did not log in MARS dates and times for PRN narcotic medications were being administered to R1 which poses an immediate health safety or personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Aug 16, 2023

Plan of correction: Plan of Correction POC Licensee agrees to conduct a PRN training for all medication technicians by the pharmacy by POC due date 09/15/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a)(14) · Plan of correction due date: Sep 15, 2023

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff (14) Current centrally stored medications as specified in Section 87465, Incidental Medical and Dental Care Services. This requirement was not met as evidenced by Licensee was logging R1's Buspirone medication as being given, yet medication had been discontinued since 2019 which poses a potential health safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 16, 2023

Plan of correction: Plan of Correction Poc Licensee agrees to submit a written plan to licensing on how this regulation will be met by POC due date 09/15/23.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA)'s Shawna Doucette and Brianna Miranda arrived at the facility unannounced to conduct the Required Annual Inspection. LPA's met with Administrator Ramona Eleco. LPA's disclosed the purpose of the inspection and was granted entry into the facility by the Administrator. A tour of the facility was conducted with the Administrator. The residence was set at 74 F temperature and free of passageway obstructions inside and outside. Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked Medication room. Cleaning supplies were in a locked closet. Smoke detectors and carbon monoxide detectors were checked and operating. Smoke detectors are hard wired with a fire panel and pull station fire alarm. Facility has a fire sprinkler system. Fire extinguishers were charged and had service dates of 05/06/23. There was outdoor seating for the residents. Resident, medication and staff records were reviewed. Current first aid and CPR were reviewed.. See LIC809C for continuance. Due to time constraints deficiencies are listed below and citations will be issued at a later date. LPAs will return to the facility at a later date or an appointment at the Regional Office will be scheduled. Licensee/Administrator. LPAs observed the following deficiencies: Medication errors, medication storage, medication logs, no staff training in all areas, inadequate staffing, no plan of operation, no dementia plan in plan of operation, trash cans without lids, strong urine odor, no restricted health care plans, staff administering injections, no skid mats in shower, shared bathroom needs cleaning, pests were observed in resident bathroom and pest droppings were observed in kitchen, hot water over 125 F and under 85 F, resident records are not current/missing signatures/conflicting information, resident records are accessible in unlocked cabinet in common area, no updated physicians reports, reappraisals, needs and service plans ect., R2 has full bed rails without a doctor note, observed activities schedule but not activities were observed that were on the schedule for 06/28/23.. An exit interview was conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 28, 2023

Allegation investigated: Resident sustained a severe fracture due to staff neglect Staff are not preventing resident from smoking in the room Staff did not prevent resident from engaging in inappropriate behaviors

On 6/21/2023, Licensing Program Analyst (LPA) M. Medina conducted a subsequent visit to deliver findings on this complaint. LPA met with Ramona Eleco and stated purpose of visit. During the course of the investigation, LPA toured facility, conducted interviews and gathered documentation. Based on review of records and interviews conducted, the allegation of resident sustained a severe fracture due to staff neglect is UNSUBSTANTIATED. During interviews and review of records, LPA reviewed incident report from facility that documented R1 having an unwitnessed fall in their bedroom and was transported by ambulance for treatment. Unsubstantiated Based on interviews conducted, the allegation of staff are not preventing resident from smoking in the room is UNSUBSTANTIATED. During facility tour, LPA observed room to be odor free, R1 is in a shared room and roommate is a smoker, however smoking is only allowed outside in designated smoking area. Administrator stated during interview that there was one occurrence where staff observed a smoked cigarette bud in an empty soda bottle while cleaning the room. Based on interviews conducted, the allegation of staff did not prevent resident from engaging in inappropriate behaviors is UNSUBSTANTIATED. During interviews, there was no knowledge of any resident being present in the dining room during meal time without clothing. This Department has investigated the complaint alleging the above allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies cited. Exit interview conducted with Administrator and a copy of this report provided for facility recordsthe state’s words, verbatim · CDSS document, Jun 21, 2023 · control 24-AS-20230208151352

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced visit to follow up on a case management that occurred on 5/9/23. LPA conducted a case management to address the deficiencies. LPA met with Administrator Ramona Eleco. LPA reviewed and obtained copies of R1's file. LPA interviewed staff and resident. After conducting interviews it was found R1 was retained with a prohibited health condition. Administrator was unable to provide documentation of a health care plan for R1. Administrator did not contact Licensing prior to R1 being released from the hospital to obtain an exception for R1. Administrator did not request an exception for R1's prohibited condition. After conducting interviews with staff and residents it was found staff which are not skilled professionals were administering injections to R1. On 6/5/23, R2 was admitted to facility with a restrictive health condition. Facility does not have a care plan from Home Health in the facility. LPA obtained a copy of R2's file. Civil penalty was issued Per California Code of Regulations, Title 22, Division 6, Chapter 8, for 87616(a)(b)(1)(2) for a repeat violation and deficiencies were cited. Refer to 809D. An exit interview was conducted and a copy of this report, plan of corrections and appeal rights were provided to Administrator Ramona Elecothe state’s words, verbatim · CDSS document, Jun 9, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Jun 13, 2023

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Licensee retrained a resident (R1) with a prohibited health condition (unstagable wound), which poses an immediate health, safety, and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 9, 2023

Plan of correction: Plan of Correction POC Licensee agrees to find appropriate care for R1 by POC due date 06/13/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87616(a)(b)(1)(2) · Plan of correction due date: Jun 16, 2023

87616 Exceptions for Health Conditions (a) As specified in Section 87209, Program Flexibility, the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means. (b) Written requests shall include, but are not limited to the following: (1) Documentation of the resident's current health condition including updated medical reports, other documentation of the current health, prognosis, and expected duration of condition. (2) The licensee's plan for ensuring that the resident's health related needs can be met by the facility. This requirement was not met as evidenced by Licensee did not have or submit a restricted/prohibited health care plan to licensing for approval for R1's prohibited health condition which poses a potential Health, Safety or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Jun 9, 2023

Plan of correction: Plan of Correction POC Licensee agrees to submit in writing clear of this regulation and how it will be met in the future by POC due date. Repeat violation Civil Penalties issued.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87629(b)(1) · Plan of correction due date: Jun 12, 2023

87629 Injections (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensees who admit or retain residents who require injections shall be responsible for the following: (1) Ensuring that injections are administered by an appropriately skilled professional should the resident require assistance. This requirement was not met as evidenced by: Licensee's staff which are not skilled professionals were administering injections for R1's restricted health condition which poses an immediate health, safety and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 9, 2023

Plan of correction: Plan of Correction. Licensee agrees to submit in writing the understanding of this regulation.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(d)(2) · Plan of correction due date: Jun 16, 2023

87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidence by: Administrator has recieved several citations under Title 22, with repeat violations which poses a potential health safety and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 9, 2023

Plan of correction: Plan of Correction POC Administrator agrees to review Title 22 regulations regarding all restrictive/prohibited health conditions and when to obtain an exception and will submit in writing the understanding of these regulations and the improtance of understanding Title 22 by POC due date 06/16/23

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced visit to follow up on a case management that occurred on 5/9/23. LPA conducted a case management to address the deficiencies. LPA met with Administrator Ramona Eleco. LPA reviewed and obtained copies of C1's file. LPA interviewed staff and resident. After conducting interviews it was found C1 was retained with a prohibited health condition. Administrator was unable to provide documentation of a health care plan for C1. Administrator did not contact Licensing prior to C1 being released from the hospital to obtain an exception for C1. Due to time constraints and further review needed, LPA will return at a later date to issue citations and possible civil penalties if warranted. An exit interview was conducted with the Administrator and a copy of this report was provided to Administrator Ramona Eleco.the state’s words, verbatim · CDSS document, May 20, 2023

Allegation investigated: Staff inappropriately touched resident Staff failed to prevent residents from being inappropriately touched by another resident Staff handled residents in a rough manner Staff failed to provide a safe and comfortable environment for residents Staff failed to safeguard resident's personal belongings Staff mismanaged resident's medication Staff failed to meet resident's needs Staff failed to treat resident with dignity and respect

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on a complaint investigation. LPA Hurt met with facility Administrator Ramona Eleco, and explained the purpose of today's visit. Regarding the allegation staff inappropriately touched resident. Department of Social Services previously investigated the allegation of Reporting Party (RP) being inappropriately touched by Staff 1. Due to inconsistent statements obtained from RP during interviews, and law enforcement also indicating insufficient information that a crime was committed this was found to be UNSUBSTANTIATED Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Continued... Unsubstantiated ..Continued Regarding the allegation staff failed to prevent residents from being inappropriately touched by another resident. RP initially stated Resident 1 informed RP that Resident 2 was inappropriately touching Resident 3, and Resident 4. RP then changed the story and stated they witnessed these incidents happen. During interviews conducted Resident 3, and Resident 4 both deny being inappropriately touched by Resident 2. Based on interviews conducted during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation staff handled residents in a rough manner. RP offered broad, and insufficient information regarding the incident of Staff 1 handling residents roughly. RP stated sometime in May or June 2022, Staff 1 who used to work at the facility handled the other residents in a rough manner and on an unknown date pushed a resident (Name unknown). Department of Social Services was unable to interview the resident allegedly pushed by Staff 1 as RP never provided a name during the investigation. Based on interviews conducted during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation staff failed to provide a safe and comfortable environment for residents. LPA Hurt interviewed 3 facility Residents who all stated they did feel safe and comfortable at the facility. The three residents interviewed stated staff is nice and treats them very well. Resident 6 stated they feel safe living at the facility and is very happy with the living situation. Resident 6 stated the caregivers, office staff, and even kitchen make the residents feel comfortable at the facility. LPA Hurt observed facility staff having positive interactions with Residents, including playing games, raffling prizes, and giving them dessert. Based on interviews conducted, documentation obtained and reviewed during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. ...Continued Regarding the allegation staff failed to safeguard resident's personal belonging. RP stated during interviews RP witnessed Staff 2 remove a wallet from Resident 5’s pocket and pass to another unnamed facility staff member. Resident 5 is no longer a resident at the facility and is not available to be interviewed. Facility Administrator stated Resident 5 often picked up items at the dining tables such as sugar, plastic spoons, and any items out on the table. Facility Administrator stated Resident 5 was unable to handle money, and never had a wallet. Staff 2 stated during interview they would reach into Resident 5’s pockets to remove sugar packets or any items collected and put in their pockets during mealtimes. Facility Administrator, and Staff 2’s recollection of events are identical. Based on interviews conducted, documentation obtained and reviewed during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation staff mismanaged resident's medication. RP stated during interviews RP does not sleep well and wants to be given meds before the usual 0400 a.m. to 0600 a.m. regularly scheduled medication pass so RP can go back to sleep. RP stated medications are being given daily but RP wants them at a specific time outside of the normal schedule, and the facility is not accommodating this request. Based on interviews conducted, documentation obtained and reviewed during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. ..Continued Regarding the allegation staff failed to meet resident's needs. LPA Hurt spoke with 3 facility residents who all stated the staff assists them with their needs, and their needs are being met. Resident 6 stated facility staff will go above and beyond to assist residents with their needs. Based on interviews conducted during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation staff failed to treat resident with dignity and respect. LPA Hurt interviewed 3 facility residents stated staff does treat them with dignity and respect. The three residents interviewed stated staff is nice and treats them very well. Resident 6 stated they have never witnessed facility staff being anything but respectful to the residents. Based on interviews conducted during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies cited today Per Title 22 Regulations. Exit interview conducted with Administrator Ramona Eleco, and a copy of this report provided.the state’s words, verbatim · CDSS document, May 18, 2023 · control 24-AS-20230207130450

Allegation investigated: Resident is not receiving proper care, resulting in multiple ER visits for UTI

Licensing Program Analyst (LPA) Shawna Doucette arrived unannounced to conduct a 10 day complaint investigation. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Administrator Ramona Eleco. LPA obtained copies of R1's file and interviewed Administrator. LPA reviewed files. After review of files, facility does not have a restricted health care plan for R1's restricted health condition. R1's needs and service plan has not been updated since 09/19/19 and does not include R1's restricted health condition. LPA requested copies of inicdent reports for R1's hospitalizations. Administrator was unable to provide incident reports for R1 for 2/24/23, 03/18/23 and 4/18/23. LPA requested copies of home health records for R1. Adminsitrator was unable to provide records and requested the records from home health during the visit. Administrator was only able to provide dates home health responded to the facilty for R1 and had no further documentation. Substantiated Based on record review and interviews, the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. An exit interview was conducted with Administrator Ramona Eleco and a copy of this report along with appeal rights and plan of correction were provided.the state’s words, verbatim · CDSS document, Apr 26, 2023 · control 24-AS-20230419161010

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87616(a)(b)(1)(2) · Plan of correction due date: May 8, 2023

87616 Exceptions for Health Conditions (a) As specified in Section 87209, Program Flexibility, the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means. (b) Written requests shall include, but are not limited to, the following: (1) Documentation of the resident's current health condition including updated medical reports, other documentation of the current health, prognosis, and expected duration of condition. (2) The licensee's plan for ensuring that the resident's health related needs can be met by the facility. This requirement was not met as evidenced by Licensee did not have or submit a restricted health care plan to licensing for approval for R1's restricted health condition which poses a potential Health, Safety or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 26, 2023

Plan of correction: Plan of Correction POC Licensee agrees to submit a plan of care for R1's restricted health condition by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Shawna Doucette went to the facility unannounced to conduct a 10 day complaint investigation, where other deficiencies were observed during the course of the investigation. LPA conducted a case management to address the deficiencies. LPA met with Administrator Ramona Eleco. LPA reviewed R1's file. LPA interviewed Administrator Ramona Eleco. LPA requested copies of all incident reports from 1/1/23 until 4/19/23 for R1's hospitalization. Administrator was able to provide an incident report for 1/29/23 but was not able to provide incident reports for 2/24/23, 3/18/23 or 4/18/23. LPA requested copies of staff training for R1's restricted health condition. Administrator was unable to provide copies of training for R1's restricted health condition. LPA requested copies of home health records. Administrator contacted home health and requested the records of care for R1. Administrator was only able to provide dates home health came to the facility to care for R1 and was unable to provide any further information. The above deficiencies were cited per California Code of Regulations, Title 22, Division 6, Chapter 8, on attached 809D. An exit interview was conducted with the Administrator and a copy of this report, plan of correction with appeal rights was provided to Administrator Ramona Eleco.the state’s words, verbatim · CDSS document, Apr 26, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: May 8, 2023

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by Licensee did not submit incident reports for R1's hospitalization on 2/24/23, 3/18/23 and 4/18/23 which poses a potential Health, Safety or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 26, 2023

Plan of correction: Plan of Correction POC LIcensee agrees to submit in writing the understanding of this regulation and how the regulation will be met by POC due date 05/08/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87613(a)(2)(A)(B) · Plan of correction due date: May 12, 2023

87613 General Requirements for Restricted Health Conditions (a) Prior to admission of a resident with a restricted health condition, the licensee shall: (2) Ensure that facility staff who will participate in meeting the resident’s specialized care needs complete training provided by a licensed professional sufficient to meet those needs. (A) Training shall include hands-on instruction in both general procedures and resident-specific procedures (B)Training shall be completed prior to the staff providing services to the resident.This requirement was not met as evidenced by: Licensee did not have staff trained by a licensed professional to care for R1's restricted health condition which poses a potential Health, Safety or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 26, 2023

Plan of correction: Plan of Correction POC Licensee agrees to have staff trained for the care of R1's restricted health condition by a licensed professional. Licensee agrees to submit documentation of training by the licensed professional, a roster of staff trained, and the responsibilities of staff for R1's retricted health condition by POC due date 5/12/23

Allegation investigated: Improper use of postural supports

Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to conduct a subsequent interview and deliver complaint findings. LPA met with and explained the reason for the visit with Administrator (AD) Ramona Eleco. During the visit, LPA toured the facility and conducted resident and staff interviews. Resident (R1) was observed sitting in a wheelchair in the dining room waiting for lunch. A padded strap was wrapped around R1 which fastened in the back of the wheelchair. R1 was unable to reach the fastener or release the belt. Additionally, during ths visit, R1 was observed resting in bed with full side rails in raised position. Based on observation and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D. An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with AD, whose signature on this form confirms receipt of these documents. Substantiatedthe state’s words, verbatim · CDSS document, Feb 9, 2023 · control 24-AS-20221103095508

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(2) · Plan of correction due date: Feb 16, 2023

87608 Postural Supports (a) Based on the individual's.... the facility shall provide assistance and care for the resident in those activities of daily living...postural supports may be used under the following conditions.(2) Postural supports shall be fastened or tied in a manner that permits quick release by the resident. This requirement was not met as evidenced by: Licensee did not ensure that R1's postural support lap belt permits quick release by the resident. R1's lap belt fastenes in the back of R1's wheelchair, R1 cannot reach it. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 9, 2023

Plan of correction: AD has agreed to provide R1 with a self releasing lap belt and obtain a revised physician's order. AD will provide proof of the new belt and physician's order to CCLD via pictures and video via email by the due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Feb 16, 2023

87608 Postural Supports (a) …the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include….limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care……. This requirement was not met as evidenced by: Licensee did not ensure that full bed rails were only used for residents receiving hospice. R1 has an order for half side rails. R1 was observed in bed will full bedrails in raised position. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 9, 2023

Plan of correction: AD has agreed to have the full rails removed and half rails placed. AD will obtain a revised physician's order for the half rails. Proof of correction will be provided with pictures to be emailed to CCLD by the due date.

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Eviction procedures not followed Administrator does not ensure dignity in relationship with resident Lack of care and supervision: residents having inappropriate interactions

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to open a complaint investigation. LPA Hurt met with facility Administrator Ramona Eleco and explained the purpose of today's visit. Regarding the allegation Eviction procedures not followed. Based on LPA interviews with facility Residents, and Administrator Ramona Eleco, and facility records reviewed the facility is following eviction procedures. LPA Hurt interviewed Administrator Mona who stated she never verbally told Resident 1 to move from the facility. Administrator Ramona Eleco stated she never gave Resident 1 a written eviction notice, and only gave them written reminders to pay arrears from past rent owed. LPA Hurt interviewed Resident 1 who stated Administrator Mona told them verbally she needed to move out of the facility in 11 days but was not provide any written notices documenting an eviction. Resident 1 stated her roomate Resident 2 heard Administrator Mona tell them to move out within elven days. LPA Hurt interviewed Resident 2 who stated Administrator Mona never asked Resident 1 to move out of the facuility within elven days. Continued on 9099C... Unsubstantiated ...Continued from 9099 LPA Hurt reviewed facility records documenting Resident 1's several reminders to pay past due rents owed, and also Care Conferences addressing the issues of consistent Non payment of rent. Therefore this allegation is UNSUBSTANTIATED. A finding that an allegation is unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Regarding the allegation Administrator does not ensure dignity in relationship with resident. Based on LPA interviews conducted the Administrator does have dignity in their relationship with resident. LPA Hurt interviewed facility Administrator Mona who stated they have never called Resident 1 any bad names to anyone and never would. Resident 1 stated facility Administrator Mona never directly called her any names, but she heard Resident 3’s son over the phone saying, “Administrator Mona told him Resident 1 is a thief.” Based on the conflicting details in interviews conducted this allegation is UNSUBSTANTIATED. A finding that an allegation is Unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Regarding the allegation Lack of care and supervision: residents having inappropriate interactions. Based on interviews conducted the facility residents are not having inappropriate interactions. LPA Hurt interviewed Resident 4 who stated she has not recently had any inappropriate interactions with any other facility residents. Therefore, this allegation is UNSUBSTANTIATED.. A finding that an allegation is Unsubstantiated means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Exit interview conducted with Administrator Ramona, and a copy of this report left at the facility.the state’s words, verbatim · CDSS document, Jan 27, 2023 · control 24-AS-20230119130740

Allegation investigated: Staff are not properly trained

On 01/18/2023, Licensing Program Analysts, L. Salazar and M. Garza arrived at the facility unannounced to deliver findings on the above allegation. LPAs were greeted by Administrator, stated the purpose of the visit and were allowed entry into the facility. During the investigation, LPA conducted interview with Administrator and reviewed the medication training records for all staff that administer medications. (Med-Techs). Based on interview with Administrator and records review conducted, 5 out of 5 staff training records, evidence that staff do not have the required 8 hour annual medication training. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. If not corrected, this poses a potential risk to residents in care. (Continued on 9099-C) Substantiated (Continued from 9099) An exit interview was conducted, and a plan of correction was reviewed and developed with Administrator with a Plan of correction date of 02/20/2023. A copy of this report and appeal rights were discussed and provided to Administrator, Ramona Eleco, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Jan 18, 2023 · control 24-AS-20221121164233

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.69(b) · Plan of correction due date: Feb 3, 2023

§1569.69 Employees assisting residents with self-administration of medication; training requirements. (b) Each employee who received training...and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication related issues in each succeeding 12-month period. This requirement was not met as evidenced by LPAs interview with Administrator and records review of staff training show last medication training's for current staff were in 2019. If not corrected, this poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Jan 18, 2023

Plan of correction: Administrator will provide and complete the required annual medication training for all staff assisting in medications by 02/20/2023. Administrator will send proof of training to LPA via email.

Allegation investigated: Linens provided to resident in care are not in good repair Resident did not receive proper food service

On 1/18/2023 Licensing Program Analysts (LPA’s) M. Garza and L. Salazar arrived at facility unannounced to deliver findings on complaint allegations listed above. LPAs introduced selves and met with Administrator, Ramona Eleco. LPAs disclosed reason for visit and were permitted entry into the facility but were not COVID prescreened at entry. LPAs toured facility and completed a health and safety check on residents in care. During investigation LPA completed interviews with staff and residents, reviewed order invoices and completed tours of the facility. Interviews disclosed that residents did not have concerns with the linens at the facility or food service. Linen inspection by LPA did not indicate linens were in need of replacement nor did LPA observe linens to be stained or torn. LPA completed tour of the facility at lunch and did not observe trays to be left in hallways or in rooms. CONT... Unsubstantiated CONT... Although the allegations may or may not have occurred the preponderance of evidence does not meet the Departments standard. The allegations listed above are UNSUBSTANTIATED. Exit interview completed with Administrator, Ramona Eleco. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 18, 2023 · control 24-AS-20221114104341

Allegation investigated: Facility is in disrepair

On 1/18/2023 Licensing Program Analysts (LPAs) M. Garza and L. Salazar arrived at facility to completed an unannounced initial complaint visit. LPAs introduced selvesand were permitted entry into facility. LPAs were not COVID pre-screened upon entry. LPAs met with Administrator, Ramona Eleco and discussed reason for visit. LPAs completed a health and safety check on residents in care. Residents observed in common areas and in rooms. During visit LPAs completed interviews with staff and residents. LPAs requested a staff and resident roster with contact information. Rooms toured were observed to be in need of repair. Rooms 29, 43 and 48 are not functioning and or not funtioning properly. The allegation listed above is found to have occurred and the preponderance of evidence has been met per Title 22. The allegation is SUBSTANTIATED.the state’s words, verbatim · CDSS document, Jan 18, 2023 · control 24-AS-20230117132733

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 27, 2023

87303 Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by LPA's observations in being that 3 of 6 rooms observed with shower not funtioning or not functioning properly. This is a potential personal rights, health or safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 18, 2023

Plan of correction: Maintence to fix any and all showers not functioning and/or not functioning properly. Administrator to provide in-service for all staff. Administrator to provide a copy of training material and sign in sheet for training provided and a maintence log for corrections made. Administrator to submit to CCL by POC date.

Type of visit: Case Management - Deficiencies

On 1/18/2023 Licensing Program Analysts (LPA’s) M. Garza and L. Salazar arrived at facility unannounced to complete a case management visit on deficiencies found during previous complaint visit. LPAs introduced selves and met with Administrator, Ramona Eleco. LPAs disclosed reason for visit and were permitted entry into the facility. LPAs were not COVID pre-screened at entry. LPAs toured facility and completed a health and safety check on residents in care. The following was found on complaint visit (11/22/2022): Upon entry LPA observed a sign at the front entrance stating “visitors limited due to renovations” (renovations started 11/14/22), food in kitchen improperly stored in freezer (food observed with freezer burn and in incorrect freezer bags), laundry room unlock with chemicals accessible to residents with dementia. Exit interview completed with Administrator, Ramona Eleco. Deficiencies cited on 809-D. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jan 18, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(11) · Plan of correction due date: Feb 1, 2023

87468.1 Personal Rights of Residents in All Facilities (11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement was not met as evidence by LPA observation of a sign at the front entrance stating “visitors limited due to renovations” (renovations started 11/14/22). This poses a potential personal rights, health and/or safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 18, 2023

Plan of correction: Administrator to provide in-service for all staff. Meet with resident counsel for visitation. Administrator to provide a copy of training material and sign in sheet for training provided. Administrator to submit to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(g) · Plan of correction due date: Feb 1, 2023

87555 General Food Service Requirements (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement was not met as evidence by LPA observation of food in kitchen improperly stored in freezer (food observed with freezer burn and in incorrect freezer bags. This poses a potential personal rights, health and/or safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 18, 2023

Plan of correction: Administrator to provide in-service for all staff. Administrator to provide a copy of training material and sign in sheet for training provided. Administrator to submit to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(f)(2) · Plan of correction due date: Feb 1, 2023

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement was not met as evidence by LPA observation of laundry room unlock with chemicals accessible to residents with dementia. This poses a potential personal rights, health and/or safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 18, 2023

Plan of correction: Administrator to provide in-service for all staff. Administrator to provide a copy of training material and sign in sheet for training provided. Administrator to submit to CCL by POC date.

Type of visit: Case Management - Incident

I was at the above facility conducting a case management visit to follow up on an incident occurred on 12/31/2022. I met with facility administrator Ramona Eleco and informed her the purpose for the visit. During the visit we toured the affected area and discussed updated information regarding the incident.the state’s words, verbatim · CDSS document, Jan 4, 2023

Allegation investigated: Staff did not asssit resident with toileting needs

Licensing Program Analyst (LPA) Darius Williams conducted an unannounced follow up visit. LPA Williams met with staff, discussed the purpose of the visit, and conducted a tour of the facility by himself. The Administrator, Ramona Eloco arrived at a later time. LPA Williams observed residents eating breakfast in the dining room and a total of four staff conducting various tasks in the hallways. LPA Williams met Resident 1 (R1) in their bedroom. R1 reported it has taken staff up to 30 minutes to respond for assistance. LPA Williams sat in the bathroom and pulled the chord,(notifies staff assistance is required) and started a timer on LPA Williams watch at approximately 7:45 a.m. According to LPA Williams watch, it took approximately 7 minutes for a staff to respond and assist R1. *Continued on LIC 9099C* Unsubstantiated According to interviews conducted on 10/20/2022, three residents reported they have no concerns regarding staff responding to their pull chord. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 18, 2022 · control 24-AS-20221018105202

Allegation investigated: Facility staffing not meeting residents needs.

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. I met with administrator, Ramona Eleco and informed her the purpose of the visit. During this visit, the Department has investigated via conducting interviews and record review pertaining to the complaint alleging: Facility staffing not meeting residents needs. Based on the interviews conducted and/or records review there were not preponderance of evidence to show that facility's staffing are not meeting resident's needs, therefore the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 28, 2022 · control 24-AS-20221025140658

Allegation investigated: Staff speak inappropriately to resident in care Staff do not safeguard resident's personal belongings Resident's room is in disrepair

On 10/25/22, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct the required 10 day site inspection. LPA was greeted by Administrator, explained the purpose of the visit and was allowed entry into the facility. LPA met with Administrator to discuss allegations. LPA toured the facility and conducted interviews. Based on the information received, we have found that the complaint allegations are UNFOUNDED, meaning the allegations are false, could not have happened and or is without reasonable basis, therefore, we have dismissed the complaint. Exit interview conducted. A copy of this report was provided to Administrator. No deficiencies Unfoundedthe state’s words, verbatim · CDSS document, Oct 25, 2022 · control 24-AS-20221017131631

Type of visit: POC

On 10/25/22, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct Plan of Correction visit. LPA was greeted by Administrator, explained the purpose of the visit and was allowed entry into the facility. During a visit on 09/21/22, deficiencies were cited. Administrator completed the Plans of corrections prior to due date and all deficiencies have been cleared. LPA provided Administrator with a plan of correction letter evidencing the corrections were made. An exit interview conducted. No deficiencies cited.the state’s words, verbatim · CDSS document, Oct 25, 2022

Allegation investigated: Facility is unsanitary.

On 09/21/2022 Licensing Program Analysts (LPAs) V Gorban and L Salazar arrived unanounced to the facility stated above. LPAs greeted and were allowed entry into facility. Covid protocol was observed. During the investigation LPAs toured the facility and observed what appeared to be bodily fluids on the walls of all three hallways. LPAs observed multiple fly traps hanging from the ceiling, above the dining tables where residents were eating, light fixtures in the halls were observed to have cobwebs and bugs, Hallway doors leading to the outside courtyard were observed to be stained with dirt. Based on LPAs observations, the preponderance of evidence standard has been met, therefore, the allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is cited on the attached 9099D. If not corrected, this poses an potential risk to residents in care. An exit interview was conducted with Administrator. A plan of correction was developed with Administrator and reviewed with LPA. A copy of this report and appeal rights were discussed and also provided to Administrator. Substantiatedthe state’s words, verbatim · CDSS document, Sep 21, 2022 · control 24-AS-20220714131348

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 5, 2022

Maintenance and Operation 87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by LPAs observation of facility doors stained with dirt, fly traps hanging over dining room tables and light fixtures surrounded with cobwebs and bugs.the state’s words, verbatim · CDSS document, Sep 21, 2022

Plan of correction: Administrator will clean walls, light fixtures and doors. Administrator will paint hallways and doors to remove stains and submit proof of correction by way of pictures by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(a)(2)(B) · Plan of correction due date: Oct 5, 2022

Infection Control Requirements 87470 (a) A licensee shall ensure that infection control practices are maintained as follows:(2)Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows:(B) Walls and window coverings... shall be dusted or cleaned on a regular schedule to ensure they are safe and sanitary or when they are visibly contaminated or soiled. Walls and window coverings in resident care areas shall be dusted or cleaned on a regular schedule to ensure they are safe and sanitary or when they are visibly contaminated or soiled. This requirement is not met as evidenced by LPAs observation of facility hallway walls that were stained with feces and bodily fluids.the state’s words, verbatim · CDSS document, Sep 21, 2022

Plan of correction: Administrator will complete cleaning facility hallway and ceiling lights from cobwebs and bugs. Once done Administrator will notify CCLD when job is completed by 10/05/2022

Allegation investigated: Facility is not maintained in good repair Facility alarm makes the residents uncomfortable

On 09/21/22, Licensing Program Analysts (LPAs) L. Salazar and V. Gorban arrived at the facility unannounced to deliver findings on the above allegations. LPAs were greeted by Administrator, stated purpose of the visit and were allowed entry into the facility. During the investigation, LPAs toured the facility and observed 3 out of 6 interior facility doors that lead to the outside courtyard tohave holes in them and are in need of repair. Floor in the entry and common area of the facility are in disrepair. LPAs heard the continuous loud beeping of the call light system, which travels throughout the facility until calls are answered. LPA Salazar conducted interviews with residents that stated the beeping occurs all day long and causes mental distress. (continued on 9099-C) Substantiated (Continued from 9099) Based on LPAs audible and visual observations and interviews with residents, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies is being cited on the attached 9099-D. An exit interview was conducted with Administrator. A copy of this report and appeal rights were provided to Administrator and a plan of correction was developed by Administrator and reviewed with LPA.the state’s words, verbatim · CDSS document, Sep 21, 2022 · control 24-AS-20220713124246

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 21, 2022

Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by LPAs observation of holes in interior facility doors that lead to the outside and floor in the entrance of the facility was in disrepair.the state’s words, verbatim · CDSS document, Sep 21, 2022

Plan of correction: Administrator will replace the 3 broken doors and provide pictures / receipts evidencing the new doors by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(d)(2) · Plan of correction due date: Oct 21, 2022

Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities:(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement was not met as evidenced by LPAs interviews with residents and LPAs observation of the auditory alarm system that is continuously beeping loudly throughout the facility. Interviews with residents state this is causing mental distress.the state’s words, verbatim · CDSS document, Sep 21, 2022

Plan of correction: Administrator will submit a plan of action on how to address the loud beeping sounds of the call lights by POC date.

Allegation investigated: Staff handled resident in a rough manner

On 09/21/22, Licensing Program Analysts (LPAs) L. Salazar and V. Gorban arrived at the facility unannounced to deliver findings on the above allegation. LPAs were greeted by Administrator, stated purpose of the visit and were allowed entry into the facility. During the investigation, LPA Salazar conducted interviews with staff, residents and Administrator. Interviews reveal there was no other witness to the allegation that staff handled the Resident R1 in a rough manner. R1 has sinced passed and was not available for interview. Although the allegation may have happened, there is not a preponderance of evidence to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED Exit interview conducted and copy of report was left with Administrator. Nothe state’s words, verbatim · CDSS document, Sep 21, 2022 · control 24-AS-20220712140025

Allegation investigated: Facility is unsanitary.

This allegation was incorrectly documented on this complaint, it belongs to complaint number 24-AS-20220714131348. On 09/21/2022 Licensing Program Analysts (LPAs) V Gorban and L Salazar arrived unanounced to the facility stated above. LPAs greeted and were allowed entry into facility. Covid protocol was observed. During the investigation LPAs toured the facility and observed what appeared to be bodily fluids on the walls of all three hallways. LPAs observed multiple fly traps hanging from the ceiling, above the dining tables where residents were eating, light fixtures in the halls were observed to have cobwebs and bugs, Hallway doors leading to the outside courtyard were observed to be stained with dirt. Based on LPAs observations, the preponderance of evidence standard has been met, therefore, the allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is cited on the attached 9099D. If not corrected, this poses an potential risk to residents in care. An exit interview was conducted with Administrator. A plan of correction was developed with Administrator and reviewed with LPA. A copy of this report and appeal rights were discussed and also provided to Administrator. Substantiatedthe state’s words, verbatim · CDSS document, Sep 21, 2022 · control 24-AS-20220829110252

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 5, 2022

Maintenance and Operation 87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by LPAs observation of facility doors stained with dirt, fly traps hanging over dining room tables and light fixtures surrounded with cobwebs and bugs.the state’s words, verbatim · CDSS document, Sep 21, 2022

Plan of correction: Administrator will clean walls, light fixtures and doors. Administrator will paint hallways and doors to remove stains and submit proof of correction by way of pictures by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(a)(2)(B) · Plan of correction due date: Oct 5, 2022

Infection Control Requirements 87470 (a) A licensee shall ensure that infection control practices are maintained as follows:(2)Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows:(B) Walls and window coverings... shall be dusted or cleaned on a regular schedule to ensure they are safe and sanitary or when they are visibly contaminated or soiled. Walls and window coverings in resident care areas shall be dusted or cleaned on a regular schedule to ensure they are safe and sanitary or when they are visibly contaminated or soiled. This requirement is not met as evidenced by LPAs observation of facility hallway walls that were stained with feces and bodily fluids.the state’s words, verbatim · CDSS document, Sep 21, 2022

Plan of correction: Administrator will complete cleaning facility hallway and ceiling lights from cobwebs and bugs. Once done Administrator will notify CCLD when job is completed by 10/05/2022

Type of visit: Case Management - Other

On 09/21/22, Licensing Program Analysts (LPAs) L. Salazar and V. Gorban arrived at the facility unannounced to conduct a case management visit based on information received that staff were not wearing masks in the facility. LPAs were greeted by Administrator, stated purpose of the visit and were allowed entry into the facility. COVID precautionry measures were taken at the time of entry. LPAs toured the facility and observed staff members to be wearing masks throughout the facility. LPAs met with Administrator and provided technical assistance for the latest State Public Health Officer Order from California Department of Public Health (CDPH) dated September 13, 2022 which updates the Coronavirus Disease 2019 (COVID-19) guidance for ASC facilities effective September 17, 2022. No deficiencies cited on this visit.the state’s words, verbatim · CDSS document, Sep 21, 2022

Allegation investigated: Facility ice machine is moldy Staff are not following resident's special diet physicians order

Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the initial complaint visit. LPA met with and explained the purpose of the visit and the elements of the allegations with Administrator (AD) Ramona Eleco. During the visit, LPA conducted interviews and a record review. LPA toured the dining room and observed the facility ice machine. LPA delivered the investigation findings on this day. The Department investigated the allegation: Facility ice machine is moldy. During the course of the investigation, LPA observed the facility ice machine. The ice machine is clean and free of mold inside and out. LPA observed the cleaning log and AD explained the cleaning procedure and schedule. See LIC909-C for continuation of this report Unfounded The Department investigated the allegation: Staff are not following resident's special diet physicians order. During the investigation LPA conducted interviews and a record review of R1’s Admission Agreement, Physician’s Report, Needs & Service Plan, Medication Administration Record (MAR) and a Discharge Summary from previous placement. R1 does have an order for a Special Diet which is being followed. The Physician’s ordered Special Diet does not include Meal Supplement Drinks or dairy restrictions. There was no agreement made between R1 and AD for special items to be provided by the facility. This Agency has investigated the complaints listed above. We have found that the complaints are UNFOUNDED, therefore we have dismissed the complaints. No citations were issued during this visit. An exit interview was conducted, and a copy of this report was left with AD Ramona Eleco whose signature on this form confirm receipt of these documents.the state’s words, verbatim · CDSS document, Sep 6, 2022 · control 24-AS-20220829110252

Allegation investigated: Resident care needs are not being met Facility has pests Staff are not keeping facility clean Facility is short staffed

Licensing Program Analyst (LPA) K. Kaur and Licensing Program Manager S. Moua conducted a subsequent complaint inspection to deliver findings. LPA and LPM met with Administrator Ramona and discussed the findings. The Department has interviewed staff and residents, toured the facility, and reviewed records. Based on interviews conducted, observations, and records reviewed, the above allegations are Unsubstantiated. The facility implemented monthly pest control services in every room of the facility. The facility is cleaned on a daily basis by three housekeepers. There have been no specific incidents related to lack of staffing. Exit Interview was conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 15, 2022 · control 24-AS-20220405105646

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff not properly caring for resident's wound. Facility has insects. Facility trash is not being disposed of.

Licensing Program Analyst (LPA) K. Kaur and Licensing Program Manager S. Moua conducted a subsequent complaint inspection to deliver findings. LPA and LPM met with Administrator Ramona and discussed the findings. The Department has interviewed staff and residents, toured the facility, and reviewed records. Based on interviews conducted, observations, and records reviewed, the above allegations are Unsubstantiated. The facility implemented monthly pest control services in every room of the facility. The facility is cleaned on a daily basis by three housekeepers. LPA and LPM did not observed overflow of trash. Residents with wounds are on hospice and wound care is provided by hospice or home health by skilled medical professionals. Exit Interview was conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 15, 2022 · control 24-AS-20220406135133

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff did not give medication(s) to resident according to doctor’s orders. Resident’s shower door is in disrepair.

Licensing Program Analyst (LPA) K. Kaur and Licensing Program Manager S. Moua conducted a subsequent complaint inspection to deliver findings. LPA and LPM met with Administrator Ramona. Findings were delivered. The Department has interviewed staff and residents, toured the facility, and reviewed records. Based on observation R1’s shower door was not latching and staying closed. A sample review of the medication was conducted, and files reviewed. R1 and R2 medication reviewed and was found that medication was missed and or not properly handled. Exit Interview was conducted. Substantiatedthe state’s words, verbatim · CDSS document, Aug 15, 2022 · control 24-AS-20220729080056

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Aug 16, 2022

87465(a)(4)A plan for incidental medical and dental care shall be developed by each facility. .....provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: A sample of the medication was conducted, and files reviewed. R1 and R2 medication's were reviewed and was found that medication was missed and or not properly handled.the state’s words, verbatim · CDSS document, Aug 15, 2022

Plan of correction: A reconcile is completed for all the medications given on a daily basis. On a weekly basis administrator is reviewing/ reconciling all MARs/medication.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(e)(6) · Plan of correction due date: Sep 2, 2022

87303(e)(6) (e)Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. This requirement was not met as evidenced by: Based on observation R1’s shower was not latching and staying closed.the state’s words, verbatim · CDSS document, Aug 15, 2022

Plan of correction: Shower door latch was repaired during visit

Allegation investigated: Staff did not follow COVID-19 testing protocol for symptomatic resident. Staff did not assist resident with showering as needed. Staff did not safeguard resident’s personal belongings.

Licensing Program Analyst (LPA) K. Kaur and Licensing Program Manager S. Moua conducted a subsequent complaint inspection to deliver findings. LPA and LPM met with Administrator Ramona. Findings were delivered. The Department interviewed staff and residents, toured the facility, and reviewed records. Interviews were conducted with staff and proper COVID protocol is followed for isolation and testing of residents. Based on records review R1’s shower scheduling was reviewed, and facility records when caregivers provide showers to the residents. Facility staff return personal belongings based on any labels on the clothing. Therefor the above allegations are unsubstantiated Exit Interview was conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 15, 2022 · control 24-AS-20220729080056

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff are not stopping resident from displaying genitals to residents Staff are not stopping resident from eliminating throughout the facility Resident urinated on another resident Staff do not stop residents from bullying another resident Staff do not afford a resident (s) dignity and respect in their relationships

Licensing Program Analyst (LPA) K. Kaur and Licensing Program Manager S. Moua conducted an initial complaint inspection and deliver findings. LPA and LPM met with Administrator Ramona and discussed the findings. The Department has interviewed staff and residents, toured the facility, and reviewed records. Based on interviews conducted, observations, and records reviewed, the above allegations are Unsubstantiated. R1 referenced in the complaint was newly admitted into the facility with dementia. R1 has uncontrollable bladder. Facility implemented incontinence care plan for R1 and in-service training was completed. Residents interviewed stated that facility staff redirects R1. Residents referenced in the complaint regarding bullying were interviewed and denied the allegations. Exit Interview was conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 15, 2022 · control 24-AS-20220808103534

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Water served to residents does not meet safety standards. Facility ice machine has mold.

Licensing Program Analyst (LPA) K. Kaur and Licensing Program Manager S. Moua conducted an initial complaint inspection to open the complaint. LPA and LPM met with Administrator Ramona. Findings were delivered. The Department has interviewed staff and residents, toured the facility, and reviewed records. Based on observation, the above allegations are Unfounded. Ice machine was observed and there were no signs of mold. Ice machine is deep clean every other day. Water is filtered and was checked and there were no residues observed. Exit Interview was conducted. Unfoundedthe state’s words, verbatim · CDSS document, Aug 15, 2022 · control 24-AS-20220809165407

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff retaliated against resident for complaining Staff withheld resident's medical supplies Staff spoke inappropriately to resident Staff handled resident in a rough manner

Licensing Program Analyst (LPA) K. Kaur and Licensing Program Manager S. Moua conducted an initial complaint inspection to open the complaint. LPA and LPM met with Administrator Ramona. Findings were delivered. The Department has interviewed staff and residents, toured the facility, and reviewed records. Residents’ medical supplies are from medical supply companies via insurance or families. Residents who request it will keep their supplies in their rooms. Residents with memory care will have their supplies kept, track, and inventoried by the facility. Medical supplies room was toured, and supplies were labelled for residents. Facility has a resident’s council that meets every month. Residents were interviewed regarding personal rights and care. There have been no specific incidents regarding staff handling residents roughly, speaking inappropriately to resident, or retaliation. The above allegations are Unsubstituted. Exit Interview was conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 15, 2022 · control 24-AS-20220811130931

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff inappropriately touched resident while in care Staff made inappropriate comments to resident while in care Resident's air conditioning is in disrepair

On 08/10/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above the allegations. LPA introduced self, stated the purpose of the visit and reqeusted to meet with the Administrator. LPA met with Ramona Eleco. Today's visit included interviews and a facility tour. Based on interviews conducted and observation, the allegations: Staff inappropriately touched resident while in care; Staff made inappropriate comments to resident while in care; Resident's air conditioning is in disrepair are UNSUBSTANTIATED. Although the allegations may have happened or are valid there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies issued during today's visit. An exit interview was conducted with Administrator. A copy of this report was discussed and provided to Administrator, Ramona Eleco, whose signature on this form confirms reciept of this document. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 10, 2022 · control 24-AS-20220707070324

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff did not provide adequate supervision to resident resulting in inappropriate behavior.

A Complaint visit was conducted on the date & during the times indicated above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Administrator (Admin) Ramona "Mona" Eleco. According to Admin & facility records, Resident 1(R1) sustained fall in facility courtyard when trying to get to dining room per R1 as told to S1 R1 assessed for injuries in accordance with facility policies & procedures. No other residents observed near R1. R1 did not complain of being pursued by another person. The Department has investigated the above allegation & found it to be unsubstantiated. Exit interview conduced with Admin. Report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 26, 2022 · control 24-AS-20220518121130

Type of visit: Case Management - Other

A Case management visit was conducted on the date & during the times incidated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Administrator (Admin) Ramona Eleco. Purpose of this visit was to verify that former staff (S1) is no longer working &/or on the premises of this facility. According to Admin, S1 only worked at this location for a very short time in 2020. S1 does not work at this facility & is not on the premises of this facility. Licensee provided written statement that S1 is no longer an employee & is not on facility premises. Exit interview conducted with Admin. Report provided.the state’s words, verbatim · CDSS document, May 26, 2022

Allegation investigated: Inappropriate interactions occurred between residents.

A Complaint visit was conducted on the date & during the times indicated above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Administrator (Admin) Ramona "Mona" Eleco. The Department interviewed staff & residents (R1, R2, &3). The Department also reviewed resident's records & the submitted incident report. R3 confirmed that they intervened before anything inappropriate took place between R1 & R2. R1 denied the allegation. An incident report was submitted to the Department & facility has implemented increased supervision on R2 as a result of the incident. There is not a preponderance of evident to prove alleged violation occurred, therefore the allegation is Unsubstantiated. Exit interview conducted with Admin. Report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 16, 2022 · control 24-AS-20220411164018

Type of visit: Required - 1 Year

An Annual Inspection Control visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Administrator (Admin) Ramona "Mona" Eleco. One central entry point has been designated for universal entry screening. Routine symptom screening including temperature taken & recorded daily for all staff, residents, & visitors. Infection Control signs are posted, including in bathrooms with hand washing techniques. Soap & paper towels available. Hand sanitizer available on entry & throughout the facility. Face coverings in use & available. Sufficient supply of PPEs. Infection control policies & procedures & practices in place & currently applied. No deficiencies issued. Exit interview conducted with Admin. Report Provided.the state’s words, verbatim · CDSS document, May 16, 2022

Allegation investigated: Staff are retaliating against resident for making a complaint by forcing resident to move rooms Resident's ceiling is in disrepair

On 02/02/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver complaint findings on the above allegations. LPA met with Administrator Ramona Eleco and stated purpose of visit. During the course of the investigation, the Department conducted interviews and toured the facility. LPA interviewed resident and staffs. Based on the interviews conducted, the resident and staff confirmed resident was not forced to move rooms. The Department conducted interviews and toured the facility. LPA checked and toured the ceiling in the resident’s room. Resident’s ceiling observed to not be in disrepair. The resident and staff verified that the ceiling is not disrepair. Based on interviews and observation, the allegations above is UNFOUNDED, meaning it was false, could not have happened, and/or is without reasonable basis. We have therefore dismissed the complaint. Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email. Report signed on-site. Unfoundedthe state’s words, verbatim · CDSS document, Feb 2, 2022 · control 24-AS-20211203100104

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Resident developed pressure injuries due to being left in wheelchair extended periods of time. Facility did not provide proper bed for resident.

On 02/02/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver complaint findings on the above allegations. LPA met with Administrator Ramona Eleco and stated purpose of visit. During the course of the investigation, the Department conducted interviews, toured the facility and reviewed records. LPA interviewed resident and staff. Staffs stated resident was provided with a bed upon arrival at facility. Residents records were reviewed, and interviews were conducted that confirmed no pressure injuries developed due to resident being left in wheelchair for an extended period. Based on records reviewed and interviews conducted, the allegations above are UNFOUNDED, meaning they were false, could not have happened, and/or are without reasonable basis. We have therefore dismissed the complaint. Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email. Report signed on-site. Unfoundedthe state’s words, verbatim · CDSS document, Feb 2, 2022 · control 24-AS-20211202110000

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Facility accepted resident who needed higher level of care as the result of not conducting proper pre-assessment. Facility rooms do not provide for easy passage for residents who use wheelchairs. Resident had several unwitnessed falls as the result of insufficient staffing.

On 02/02/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver complaint findings on the above allegations. LPA met with Administrator Ramona Eleco and stated purpose of visit. During the course of the investigation, the Department conducted interviews, toured the facility and reviewed records. LPA reviewed resident’s and facility record which show proper pre-assessment was conducted prior to accepting the resident to the facility. Resident’s physician report, California Assisted Living Waiver program (ALW), and assessment were reviewed and confirmed resident did not need higher level of care. LPA toured facility and observed doorways to have proper passage. Records were review and staff interviews confirm adequate staffing. Based on records reviewed, observations, and interviews which were conducted, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email. Report signed on-site. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 2, 2022 · control 24-AS-20211202110000

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On 02/02/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct case management and met with Administrator Ramona Eleco. LPA conducted interviews with staffs and reviewed records. LPA was informed by Administrator and S3 that ointment was applied to R1 without a written prescription. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report and appeal rights will be provided via email. Report signed on-site.the state’s words, verbatim · CDSS document, Feb 2, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(e) · Plan of correction due date: Feb 11, 2022

87465(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, the licensee did not comply with the section cited above when staffs applied Calmoseptine ointment to blisters on R1's bottom which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 2, 2022

Plan of correction: Licensee stated that all staff will be retrained on regulations to ensure every prescription and nonprescription PRN medication shall have a written order from a physician. Evident of staff in-service training will be submitted to department by due date. Licensee will continue to conduct an in-service training for staff quarterly and have the training documents.

Allegation investigated: Resident overdosed while in care Staff did not ensure that resident had a sufficient intake of liquids

An Complaint visit was conducted on the date & during the times identified above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Administrator (Admin) Ramona Eleco & stated purpose of visit. Continued. Unfounded Continued from Page 1. The Department reviewed resident records for Resident 1 (R1), interviewed R1, referenced in the complaint, and facility staff. Medication records did not show discrepancies. Toxicology report was unremarkable. R1 & facility staff denied R1 taking illicit drugs or medication not prescribed to R1. According to R1 hospital records there was no indications that R1 overdosed. R1 is independent & able to get own water when thirsty. Facility staff denied R1 being dehydrated & that water is always available to residents. Large water jug & juice dispenser observed in dining room that residents have access to. R1 stated that they know where the water is & is able to get water on own when thirsty. The Department has investigated the above complaints & determine them to be Unfounded. Exit interview conducted with Admin. Report Provided.the state’s words, verbatim · CDSS document, Dec 20, 2021 · control 24-AS-20211011111843

Allegation investigated: Facility is in disrepair Staff yells at resident Facility did not provide transportation arrangements to resident in care Centrally stored medications were made accessible to residents in care Staff did not notify resident's physician of resident's change in condition

An unannounced Complaint visit was conducted on the date & during the times identified above by Licensing Program Analyst (LPA) K. McClurg & Licensing Program Manager (LPM) See Moua. LPA & LPM met with Administrator (Admin) Ramona Eleco & stated purpose of visit. The Department conducted interviews with residents & staff, toured the facility & reviewed records. Based on observations the sinks & showers in resident's room were not leaking & had hot water. The Med room was observed locked with a Med Tech & residents interviewed confirmed that staff do not yell at them & transportation arrangements are provided. The Admin stated that resident's physician's are notified of changes immediately. The allegations are Unsubstantiated. No deficiencies. Exit interview conducted with Admin. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 22, 2021 · control 24-AS-20211012141149

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff are not assisting resident with hygiene needs Staff are not ensuring that resident has nutritional meals

An unannounced Complaint visit was conducted on the date & during the times identified above by Licensing Program Analyst (LPA) K. McClurg & Licensing Program Manager (LPM) See Moua. LPA & LPM met with Administrator (Admin) Ramona Eleco & stated purpose of visit. The Department interviewed resident, facility staff, and reviewed records. The resident referenced (R1) in the complaint confirmed that they are provided meals at the facility. Facility staff interviewed stated that the resident is provided showers and hygiene care, but refuses. Resident’s refusal was documented and provided along with the facility’s menu. Based on the interviews conducted and records reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are Unsubstantiated. No deficiencies issued. Exit interview conducted with Admin. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 22, 2021 · control 24-AS-20210922141659

Allegation investigated: Resident were sexually assaulted while in care Residents take illegal drugs on the premises Staff failed to provide a safe environment for resident

An unannounced Complaint visit was conducted on the date & during the times identified above by Licensing Program Analyst (LPA) K. McClurg & Licensing Program Manager (LPM) See Moua. LPA & LPM met with Administrator (Admin) Ramona Eleco & stated purpose of visit. Continued. Unsubstantiated Continued from Page 1. The Department interviewed R1, referenced in the complaint, and facility staff. R1 provided inconsistent statements and could not confirm that they were sexually assaulted or that residents take illegal drugs at the facility. Facility staff interviewed stated they have never seen R1 assaulted or residents using illegal drugs. The Department also reviewed records from the local police department and per the report, R1 refused to press charges. Based on the interviews conducted and records reviewed, there is a lack of evidence. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are Unsubstantiated. No deficiencies issued. Exit interview conducted with Admin.the state’s words, verbatim · CDSS document, Nov 22, 2021 · control 24-AS-20210825165233

Allegation investigated: Resident's room does not have a call assistance button

An unannounced Complaint visit was conducted on the date & during the times identified above by Licensing Program Analyst (LPA) K. McClurg & Licensing Program Manager (LPM) See Moua. LPA & LPM met with Administrator (Admin) Ramona Eleco & stated purpose of visit. Previous visit, LPA observed call assistance button to be availble in room for Resident 1 (R1). Button tested & observed to be operational. The Department has investigated the above allegation & determined it to be Unfounded. Unfoundedthe state’s words, verbatim · CDSS document, Nov 22, 2021 · control 24-AS-20210603100512

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5) · Plan of correction due date: Nov 23, 2021

Incidental Medical and Dental Care-The licensee shall assist residents with self administered medications as needed. MARS observed not maintained ensuring that residents are receiving assistance with rx as neededthe state’s words, verbatim · CDSS document, Nov 22, 2021

Plan of correction: Admin to submit plan to be submitted by due date that outline a plan with dates on how issue will be corrected, including staff training. Repeat Violation <8/4/21> Immediate Civil Penalty of $250 assessed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Dec 19, 2021

Maintenance and Operation-The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Cockroaches present in facility in resident rooms. Current Pest Control contract is insufficient to meet the facility need to control cockroaches.the state’s words, verbatim · CDSS document, Nov 22, 2021

Plan of correction: Admin to review current Pest Control contract & to reassess current need of facility to control cockroaches. Copy of updated Pest Control contract to be submitted by due date. Repeat Violation <8/26/21> Immediate Civil Penalty of $250 assessed.

Allegation investigated: Staff are not following licensed physicians orders as prescribed

An unannounced Complaint visit was conducted on the date & during the times identified above by Licensing Program Analyst (LPA) K. McClurg & Licensing Program Manager (LPM) See Moua. LPA & LPM met with Administrator (Admin) Ramona Eleco & stated purpose of visit. Resident MARs & Centrally Stored Medication & Destruction Record (CSMDR) reviewed for Resident 1 (R1) & random resident records. MARS not appropriately maintained - no initials that AM medications had been given. CSMDR did not reflect all medications on premises &/or medication was listed on CSMDR & medication not available for review. The Department has investigated the above allegation & has found it to be Substantiated. Deficiencies Issued Substantiatedthe state’s words, verbatim · CDSS document, Nov 22, 2021 · control 24-AS-20210413092742

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5) · Plan of correction due date: Nov 23, 2021

Incidental Medical and Dental Care-The licensee shall assist residents with self-administered medications as needed. MARS observed not maintained ensuring that residents are receiving assistance with rx as needed.the state’s words, verbatim · CDSS document, Nov 22, 2021

Plan of correction: Admin to submit plan by due date that outlined a plan with dates on how issue will be corrected, including staff training.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87645(h)(2) · Plan of correction due date: Nov 23, 2021

Incidental Medical and Dental Care-Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Variety of unidentified medications & vitamins observed in R1's room - not centrally stored or maintained in a locked locationthe state’s words, verbatim · CDSS document, Nov 22, 2021

Plan of correction: Admin to remove all items that should be centrally stored from R1's room. Admin to submit plan by due date that outlined a plan with dates on how issue will be corrected, including staff training.

Allegation investigated: Staff does not safeguard resident's personal items Staff does not have adequate sanitation procedures Staff does not assist resident with obtaining medical care in a timely manner

An unannounced Complaint visit was conducted on the date & during the times identified above by Licensing Program Analyst (LPA) K. McClurg & Licensing Program Manager (LPM) See Moua. LPA & LPM met with Administrator (Admin) Ramona Eleco & stated purpose of visit. The Department conducted interview with residents & staff, toured the facility's laundry room, & reviewed records. Based on observations, all resident's clothing are labelled & the facility has an adequate supply of laundry detergent & cleaning supplies. Based on records reviewed, R1 was referred for a sleep apnea observation on 10/19/21 & received the CPAP machine on 10/25/21 within a month of letting the facility know. The allegations are Unsubstantiated. No deficiencies issued. Exit interview conducted with Admin. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 22, 2021 · control 24-AS-20210826125814

Allegation investigated: Facility's air conditioner is broken Resident's bathroom sink and shower does not deliver hot water

An unannounced Complaint visit was conducted on the date & during the times identified above by Licensing Program Analyst (LPA) K. McClurg & Licensing Program Manager (LPM) See Moua. LPA & LPM met with Administrator (Admin) Ramona Eleco & stated purpose of visit. The Department conducted interviews with residents & staff, toured the facility & checked sinks & showers in resident's rooms, & reviewed records. Sinks & showers were observed to have hot water. The Admin denied the A/C was broken & the facility was observed to be at a comfortable temperature. The allegations are Unfounded. No deficiencies. Exit interview conducted with Admin. Unfoundedthe state’s words, verbatim · CDSS document, Nov 22, 2021 · control 24-AS-20211012125013

Allegation investigated: Facility staff is mismanaging resident's money Facility staff is chemically restraining resident Facility staff is not ensuring residents have access to an adequate amount of liquids Facility staff are not properly supervising residents

Licensing Program Analyst (LPA) Lady Cabrera conducted the complaint investigation visit to the facility. During the course of this investigation LPA interview staff and reviewed facility records relevant to the complaint investigation. There is no preponderance of evidence to prove the violations (Facility staff is mismanaging resident's money, Facility staff is chemically restraining resident, Facility staff is not ensuring residents have access to an adequate amount of liquids, Facility staff are not properly supervising residents) occurred as alleged by the complainant. This agency has investigated the complaint alleging the above violations. We have found that the complaint was unfounded, therefore we have dismissed the complaint. Administrator was provided with the LIC9099. Exit interview conducted. Unfoundedthe state’s words, verbatim · CDSS document, Aug 17, 2021 · control 24-AS-20210803084904

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff failed to administer resident's medication as prescribed. Facility falsifying residents’ logs.

Licensing Program Analysts (LPAs) Lady Cabrera and Shawna Doucette contacted the facility to commence a complaint investigation. LPA conducted a visit and took COVID-19 pre-cautionary measures. LPA identified herself and explained the purpose of the visit and the elements of the allegations with Administrator Ramona Eleco. LPAs delivered findings to Administrator. LPAs reviewed pharmacy log provided by Mercy Pharmacy. LPAs reviewed MARS log. Facility did not have a centrally stored log for residents medications to review. LPAs reviewed Resident's (R1) and (R2) medications. LPA interviewed Medication Technician and Administrator. Based on records review and staff interviews it was found that R1 and R2 missed medications. Pharmacy log stated medication for R1 was last refilled on 5/3/21 and not refilled again until 7/12/21. Mercy Pharmacy Medication is administered from pharmacy in a count of 30 pills. MARS log shows pills are being administered, however it does not reflect the amount of pills prescribed. Substantiated Based on facility records, it was discovered that staff are signing off on the MARS log indicating medication was administered, which does not reflect the amount prescribed by pharmacy records. Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division & Chapter number, are being cited on the attached LIC 9099D. Plan of correction and appeal rights was reviewed with Licensee. An exit interview was conducted with Administrator Ramona Eleco and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 4, 2021 · control 24-AS-20210723084805

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5) · Plan of correction due date: Aug 5, 2021

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (5) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by Based on records review and interviews, Licensee did not administer R1 and R2's medications as prescribed which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 4, 2021

Plan of correction: Plan of Correction POC Licensee agrees to provide medication training to staff to include centrally stored medication log and the administration of medications.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87207 · Plan of correction due date: Aug 5, 2021

\ 87207 False Claims No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was not met as evidenced by: Based on pharmacy records review and facility records review Licensee is signing off on the MARS log indicating medication were administered, which does not reflect the amount prescribed by pharmacy records, which poses an immediate health, safety, or personal rights risk to persons in care which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 4, 2021

Plan of correction: Plan of Correction POC Licensee agrees to provide a written plan of the understanding of the regulation and how it will be met in the future.